managing secondary traumatic stress - iowa• work-related stress is accepted as real and legitimate...
TRANSCRIPT
Managing Secondary Traumatic Stress
Extending the Shelf-Life of
those who work with Trauma
http://www.youtube.com/watch?v=XfmVBmDKLZI
Secondary Traumatic Stress
What is it? What does it look like? What can we do about it?
Secondary Traumatic Stress WHAT IS IT?
• AKA: vicarious trauma, compassion fatigue
• It is the resulting effects of chronic exposure to traumatic material
• Symptoms are the same as those experienced by direct exposure
• First noticed in ER nurses who had “lost their ability to nurture” (Boyle, 2011)
It’s just like regular trauma Hyper vigilance Abnormal responses to normal situations
(triggers) Withdrawal Avoidance
Trauma A person has experienced trauma if: Must feel fear, helplessness or horror (APA,
2000) Our response to trauma is innate-our body
is built to respond to trauma “A normal reaction to an abnormal event”
that can result in…
An abnormal reaction to a normal situation
Abnormal Responses to Normal Situations http://www.youtube.com/watch?v=3sOXN
_80ohM
“Most of us are abnormal in one way or
another. The thing that separates us is not the presence or absence of
abnormality but rather the depth at which our abnormalities control our
lives”
Dr. Greg Moffatt, Survivors, p.50
So about trauma: It’s a biology/chemistry thing
Trauma
It is subjective
And it messes with our thinking
Fight-Flight-Freeze How do we respond?
http://www.youtube.com/watch?v=OdOOIxcUjAs
“The expectation that we can be immersed in suffering and loss daily
and not be touched by it is as unrealistic as expecting to be able to
walk on water without getting wet. This sort of denial is no small matter”
Rachael Naomi Remen, M.D.
Recognizing STS MANIFESTATIONS
Emotional Intellectual
Physical Social
Spiritual Work
Recognizing STS Emotional:
Anger
Apathy
Cynicism
Desensitization
Discouragement
Irritability
Lessened Enthusiasm
Hopeless
Sarcastic
Recognizing STS
Intellectual/Cognitive
Difficulty concentrating
Weakened attention to detail
Disorderliness
Recognizing STS Physical:
Increased somatic complaints GI, headache, insomnia
Lack of energy/endurance
More prone to accidents
Weariness, fatigue, exhaustion
Recognizing STS • Social:
Callousness
Feelings of alienation,
estrangement, isolation
Indifference
Loss of interest in activities once
enjoyed
Unresponsiveness
Withdrawal from family &/or friends
Stress & Immunity 32 men 1 time paced memory test (active coping) 1 “gruesome” surgical video (passive
coping 1 control TV show OSU Researchers measured their saliva for
levels of S-lgA…immunoglobin that regulates immune and inflammatory responses and protecting mucosal surfaces against invasion by parasites
What they found 1. Taking the test increased the output
of S-lgA 2. Within 10 minutes of watching the
video- output of S-lgA decreased. “We conclude that acute stress can have both enhancing and
suppressive effects on secretory immunity, the IgA1 subclass in particular”
(Bosch,J. et al; 2001)
Type of stress matters.
Recognizing STS
• Spiritual: Decrease in discernment
Disinterest in introspection
Spiritual awareness
Poor judgment
Recognizing STS • Work
Absenteeism/Tardiness Avoidance of intense client/victim/patient
situations Desire to quit Diminished performance Stereotypical/impersonal communication
•Negative bias, pessimism •Loss of perspective and critical thinking
skills •Threat focus – see clients, peers,
supervisor as enemy (Tullberg, 2012)
“My glass is not only half-empty, I'm convinced someone spit in it.” ― Judy Nichols, Sportsman's Bet
System-Level Impact Distrust among collaborators/co-workers
(Hyperarousal)
+ Decreased motivation/increased absenteeism
(Withdrawal)
+ Compromised ability to manage clients’ trauma
reactions (Avoidance)
+ Loss of perspective and critical thinking
(Hyperarousal)
=
System Level Impact
Professionals that don’t show up 100% &
Poor outcomes
So now what??
Resilience 1: the capability of a
strained body to recover its size and shape after deformation caused especially by compressive stress
2: an ability to recover
from or adjust easily to misfortune or change
(Merriam-Webster, retrieved 2012)
Resilience
Resilience is not a trait that people either
have or do not have.
It involves behaviors, thoughts, and actions that can be learned and
developed in anyone (APA, retrieved 2012)
Individual Level Compassion Satisfaction Social Support Positive emotions Intentional Optimism
Managing STS Compassion satisfaction
A sense of reward,
efficacy and competence in the
role of helping others
Killian (2008)
ProQOL
http://proqol.org
Social Support Check in with colleagues - they understand your
language/humor - confidentiality Have “normal” friends - reciprocate Formulate an “A-Team”
Positive Emotions
They are developed in times of safety and rest
Positive emotions have the
ability to undo the negative effects of
traumatic stress
-decrease heart rate, vasoconstriction, blood
pressure -increases cognitive ability
Positive emotions
JOY
Positive Emotions
GRATITUDE
Positive Emotions
SERENITY
Positive Emotions
INTEREST
Positive Emotions
AMUSEMENT
Positive Emotions
INSPIRATION
Positive Emotions
AWE
Positive Emotions
PRIDE
Positive Emotions
HOPE
Positive Emotions
LOVE
Intentional Optimism To interpret situations
in the best possible light
Anticipate the best
possible outcomes On purpose
Perspective is everything
“Everything can be taken from a man
but one thing: the last of the human freedoms- to choose one’s own
attitude in any given set of circumstances, to choose one’s own
way.”
Viktor Frankl, 1945
Intentional Optimism
Train Your Brain Practice intentional
optimism Anticipate the best
possible outcomes…
On purpose.
Louis CK on perspective:
http://www.liveleak.com/view?i=aba_13
32656862
Perspective is everything
“Everything can be taken from a man
but one thing: the last of the human freedoms- to choose one’s own
attitude in any given set of circumstances, to choose one’s own
way.”
Viktor Frankl, 1945
And one more thing…
Mindfulness is good for your brain.
http://www.youtube.com/watch?v=L-IZArfQHOo
Supervisor Level
Organizational Level Change in work culture Top level “buy in” Difficult case processing/ formal &
informal Trauma Informed Care
Organizational Level
• Why should they care? • What can they do?
How does your organization support you with your stress?
Impact on Organizations
• Prevent worker turnover • Costs of hiring and training new
employees • Long-term effects on the mental and
physical health of people
Impact on Organizations
• Addressing the occupational hazard of STS is in the best interest of all involved: – Vulnerable children – The organizations responsible for their
care and protection – The workers doing the work – Society
Organizational Risk Factors • Extraordinary high caseloads • High administrative burden • Difficult clients • Conflicts with co-workers or supervisors • Climate of pervasive, ongoing change • Excessive emphasis on efficiency, cost-
effectiveness and competition • Unforgiving enviornment. “If you can’t
handle it, move aside….you’ll be replaced”
Organizational Strategies for managing STS
• Work-related stress is accepted as real and legitimate • Problem is owned by organization (not merely “problem”
workers) • Secondary trauma responses are recognized as normal
responses • Focus is on solutions (not blaming) • Support and tolerance clearly expressed to worker • Other “climate” issues (caseloads, official policy, EAP)
» Source: Sexton, 1999
Other Organizational Responses
• In-service training • Policy on secondary trauma • Ongoing program to manage secondary trauma • Regular supervision, consultation and support
groups • Professional development opportunities • Rotation in caseload and job responsibility • Health care plan with adequate health care
coverage » Source: Nelson-Gardnell & Harris, 2003
Other Organizational Responses
• Enhance the physical safety of staff • Workplace self-care groups • Flextime scheduling • Creating external partnerships with STS
intervention providers • Train organizational leaders and non-clinical
staff on STS • Provide ongoing assessment of staff risk and
resiliency » Source: National Child Traumatic Stress Network
• https://www.dmgov.org/Departments/Police/Pages/DMPDPeerSupport.aspx
• http://www.youtube.com/watch?feature=player_embedded&v=9ZvAjk9_lNQ
Final thoughts
Questions?
Contact information Brenda Bash, MS
Polk County Crisis & Advocacy Services 515.286.2020
Darci Patterson Department of Human Services
515.725.2719 [email protected]
Jennifer Sleiter MSN, ARNP Blank Children’s Hospital
515.241.4311 [email protected]